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PSORIATIC ARTHRITIS IS A COMPLEX DISEASE INVOLVING 6 KEY DOMAINS1,2

The manifestations of PsA are driven by disregulation of multiple pro-inflammatory cytokines3-17

Human silhouette illustrating the 6 key domains of psoriatic arthritis: skin psoriasis, axial disease, nail psoriasis, enthesitis, dactylitis, and peripheral arthritis

When treating psoriatic arthritis, consider the value of a medication that impacts the 6 key domains19

Visual representation based on clinical and preclinical evidence.

DMARD, disease-modifying antirheumatic drug; IFN, interferon; IL, interleukin; TNF, tumor necrosis factor; Th, T helper.

References:

  1. Gottlieb A, Korman NJ, Gordon KB, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: section 2. Psoriatic arthritis: overview and guidelines of care for treatment with an emphasis on the biologics. J Am Acad Dermatol. 2008;58(5)851-864.
  2. Gossec L, Smolen JS, Ramiro S, et al. European League Against Rheumatism (EULAR) recommendations for the management of psoriatic arthritis with pharmacological therapies: 2015 update. Ann Rheum Dis. 2016;75:499-510.
  3. Lee E, Trepicchio WL, Oestreicher JL, et al. Increased expression of interleukin 23 p19 and p40 in lesional skin of patients with psoriasis vulgaris. J Exp Med. 2004;199(1):125-130.
  4. Lowes MA, Kikuchi T, Fuentes-Duculan J, et al. Psoriasis vulgaris lesions contain discrete populations of Th1 and Th17 T cells. J Invest Dermatol. 2008;128(5):1207-1211.
  5. Yao Y, Richman L, Morehouse C, et al. Type I interferon: potential therapeutic target for psoriasis? PLoS One. 2008;3(7):e2737.
  6. Villanova F, Di Meglio P, Nestle FO. Biomarkers in psoriasis and psoriatic arthritis. Ann Rheum Dis. 2013;72 (suppl 2): ii104-ii110.
  7. Van Kuijk AW, Tak PP. Synovitis in psoriatic arthritis: immunohistochemistry, comparisons with rheumatoid arthritis, and effects of therapy. Curr Rheumatol Rep. 2011;13(4):353-359.
  8. Menon B, Gullick NJ, Walter GJ, et al. Interleukin-17+CD8+ T cells are enriched in the joints of patients with psoriatic arthritis and correlate with disease activity and joint damage progression. Arthritis Rheumatol. 2014;66(5):1272-1281.
  9. Celis R, Planell N, Fernández-Sueiro JL, et al. Synovial cytokine expression in psoriatic arthritis and associations with lymphoid neogenesis and clinical features. Arthritis Res Ther. 2012;14(2):R93.
  10. Siegel EL, Orbai AM, Ritchlin CT. Targeting extra-articular manifestations in PsA: a closer look at enthesitis and dactylitis. Curr Opin Rheumatol. 2015;27(2):111-117.
  11. Taylan A, Sari I, Kozaci DL, et al. Evaluation of the T helper 17 axis in ankylosing spondylitis. Rheumatol Int. 2012;32(8):2511-2515.
  12. Limon-Camacho L, Vargas-Rojas MI, Vazquez-Mellado J, et al. In vivo peripheral blood proinflammatory t cells in patients with ankylosing spondylitis. J Rheumatol. 2012;39(4):830-835.
  13. Kyriakou A, Patsatsi A, Vyzantiadis TA, Sotiriadis D. Serum levels of TNF-α, IL-12/23 p40, and IL-17 in psoriatic patients with and without nail psoriasis: a cross-sectional study. Scientific World Journal. 2014;2014:508178.
  14. Ebihara S, Date F, Dong Y, Ono M. Interleukin-17 is a critical target for the treatment of ankylosing enthesitis and psoriasis-like dermatitis in mice. Autoimmunity. 2015;48(4):259-266.
  15. Yamamoto M, Nakajima K, Takaishi M, et al. Psoriatic inflammation facilitates the onset of arthritis in a mouse model. J Invest Dermatol. 2015;135(2):445-453.
  16. Sherlock JP, Joyce-Shaikh B, Turner SP, et al. IL-23 induces spondyloarthropathy by acting on ROR-γt+ CD3+CD4-CD8-entheseal resident T cells. Nat Med. 2012;18(7):1069-1076.
  17. Ruutu M, Thomas G, Steck R, et al. β-glucan triggers spondylarthritis and Crohn's disease-like ileitis in SKG mice. Arthritis Rheum. 2012;64(7):2211-2222.
  18. Coates LC, Kavanaugh A, Mease PJ, et al. Group for research and assessment of psoriasis and psoriatic arthritis 2015 treatment recommendations for psoriatic arthritis. Arthritis Rheumatol. 2016;68(5):1060-1071.
  19. Marchesoni A. Oligoarticular Psoriatic Arthritis: Addressing Clinical Challenges in an Intriguing Phenotype. Rheumatol Ther. 2018;5(2):311–316.
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